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Risk of death by suicide following self-harm presentations to healthcare: development and validation of a multivariable clinical prediction rule (OxSATS)
- Source :
- Evidence-Based Mental Health; 2023, Vol. 26 Issue: 1 pe300673-e300673, 1p
- Publication Year :
- 2023
-
Abstract
- BackgroundAssessment of suicide risk in individuals who have self-harmed is common in emergency departments, but is often based on tools developed for other purposes.ObjectiveWe developed and validated a predictive model for suicide following self-harm.MethodsWe used data from Swedish population-based registers. A cohort of 53 172 individuals aged 10+ years, with healthcare episodes of self-harm, was split into development (37 523 individuals, of whom 391 died from suicide within 12 months) and validation (15 649 individuals, 178 suicides within 12 months) samples. We fitted a multivariable accelerated failure time model for the association between risk factors and time to suicide. The final model contains 11 factors: age, sex, and variables related to substance misuse, mental health and treatment, and history of self-harm. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis guidelines were followed for the design and reporting of this work.FindingsAn 11-item risk model to predict suicide was developed using sociodemographic and clinical risk factors, and showed good discrimination (c-index 0.77, 95% CI 0.75 to 0.78) and calibration in external validation. For risk of suicide within 12 months, using a 1% cut-off, sensitivity was 82% (75% to 87%) and specificity was 54% (53% to 55%). A web-based risk calculator is available (Oxford Suicide Assessment Tool for Self-harm or OxSATS).ConclusionsOxSATS accurately predicts 12-month risk of suicide. Further validations and linkage to effective interventions are required to examine clinical utility.Clinical implicationsUsing a clinical prediction score may assist clinical decision-making and resource allocation.
Details
- Language :
- English
- ISSN :
- 13620347 and 1468960X
- Volume :
- 26
- Issue :
- 1
- Database :
- Supplemental Index
- Journal :
- Evidence-Based Mental Health
- Publication Type :
- Periodical
- Accession number :
- ejs65053854
- Full Text :
- https://doi.org/10.1136/bmjment-2023-300673